peptic ulcer disease

Peptic Ulcer Disease: Causes and Symptoms

Peptic ulcer disease is when stomach acid causes an ulcer. An ulcer is an open sore and can cause pain and complications.

This disease can be gastric depending on the location. If the ulcer affects the stomach, it is a stomach ulcer. If it affects the first segment of the small intestine (duodenum), it is a duodenal ulcer. Some people have both gastric and duodenal ulcers.

In this article, we’ll discuss the causes and symptoms of peptic ulcer disease.

peptic ulcer disease - illustration comparing healthy stomach to ulcerated stomach

What Causes Peptic Ulcer Disease?

There are two main causes of peptic ulcer disease.

  1. Helicobacter pylori infections
  2. Non-steroid anti-inflammatory (NSAIDs) medications

Helicobacter pylori (H. pylori) is a bacterium that infects the stomach. It can cause stomach inflammation (gastritis), peptic ulcer disease, and stomach cancer. After an H. pylori infection diagnosis, doctors test for peptic ulcers.

To eradicate an H. pylori infection, you must take a series of antibiotics and proton pump inhibitors. Doctors may recommend adding Pepto Bismol to the therapy as well.

NSAID drugs like ibuprofen, aspirin, or naproxen are common causes of peptic ulcer disease. There is especially a risk when taken in high doses for a long period of time. In addition to causing ulcers, NSAIDs also interfere with blood clotting. Therefore, they increase the risk of bleeding.

If NSAIDs are the cause, a doctor may switch the patient to another painkiller. Alternative medicine is acetaminophen, which is not linked to ulcers. They may also add an acid blocker to the treatment. Acid blockers help prevent ulcers due to NSAIDs.

There are also medical conditions that increase the risk of peptic ulcer disease. These include:

  • Cytomegalovirus
  • Tuberculosis
  • Crohn’s disease
  • Hepatic cirrhosis
  • Chronic renal failure
  • Sarcoidosis

Very sick people or those who had surgery are at higher risk as well. Smokers also have slower healing of ulcers and often experience recurring ulcers.

There may be some common misconceptions surrounding the causes of peptic ulcers. According to the American College of Gastroenterology, they are not caused by stress, anxiety, or spicy food. However, some foods can aggravate symptoms and further irritate the stomach/duodenal mucosa.

peptic ulcer disease - woman clutching stomach in pain

What are the Symptoms of Peptic Ulcer Disease?

Many people have no symptoms at all when they have peptic ulcer disease. Some may experience mild abdominal pain. This can be either ameliorated or aggravated by food. Other digestive symptoms include nausea, vomiting, and bloating. These are possible symptoms of uncomplicated ulcers.

peptic ulcer disease - hospital room

Peptic Ulcer Disease Complications

There are four major complications of peptic ulcer disease. They often require treatment in a hospital as they can be life-threatening. They include:

  1. Bleeding
  2. Perforation
  3. Penetration
  4. Obstruction


An ulcer can bleed slowly without causing serious symptoms. In fact, it may not cause any symptoms at all. Only blood tests would reveal anemia. In other cases, a person with anemia may experience fatigue, pale skin, and shortness of breath.

If the bleeding is more serious the person can lose large amounts of blood in a short time and have black, brown, or dark red stools. A person may also vomit blood, either fresh bright red or brown that looks like coffee grounds. This type of bleeding is a medical emergency and requires hospitalization and treatment.


A perforated ulcer is also a medical emergency. This is when the contents of the stomach spill into the abdominal cavity, which can lead to infection. Symptoms are more severe and include a sudden onset of sharp intense pain in the abdomen. This worsens with any kind of movement.
The perforated ulcer can lead to septic shock, which causes increased heart rate, drop in blood pressure, and the inability to urinate.


About 5-10% of ulcers may erode through all layers of the stomach and duodenum. This leads to penetration into the pancreas, liver, and small or large intestine. Penetrated ulcers also require immediate treatment in the hospital.

Symptoms include intense abdominal pain which can irradiate to the right or to the back and a low-grade fever.


Gastric outlet obstruction due to peptic ulcer disease is rare but possible. It occurs in about 5-8% of individuals with peptic ulcers. Symptoms include vomiting undigested food, bloating, and feeling full after eating very little. It can lead to weight loss, dehydration, and other complications. This complication does require hospitalization and treatment.


Peptic ulcers affect roughly half a million Americans each year. It is important to talk to your doctor if you experience symptoms. You can always ask for an H. pylori test and alternatives to NSAID drugs since they are the most common causes of peptic ulcer disease.